Comparative effectiveness of management options for patients with small renal masses: a prospective cohort study

Abstract

With excellent oncological outcomes in all groups, nephron-sparing approaches, like PN and ablation, are preferred over RN when intervention is indicated for SRMs. AS is a reasonable option for select patients, given the comparable oncological and mental health outcomes.

Thulium Laser‐Assisted Versus Conventional Laparoscopic Partial Nephrectomy for the Small Renal Mass

“…In treating patients with SRMs, three competing factors have to be balanced: cancer control, patient morbidity, and preservation of renal function . Although LPN has gained acceptance as a minimally invasive treatment option because of its excellent surgical results and cancer control . Nonetheless, LPN demands that the surgeon have significant laparoscopic experience and skills that are necessary for expeditious intracorporeal suturing, especially in cases of warm ischemia.…”

“…The incidence of small renal masses (SRMs; tumor diameter ≤ 4.0 cm) has consistently increased during the past decades because of improvement and widespread use of imaging techniques . About of 70–90% of these tumors are found to be malignant renal cell carcinomas (RCC), which may ultimately require treatment . Nephron‐sparing surgery (NSS), especially partial nephrectomy (PN) has been considered the standard treatment for patients with these SRMs .…”

“…About of 70–90% of these tumors are found to be malignant renal cell carcinomas (RCC), which may ultimately require treatment . Nephron‐sparing surgery (NSS), especially partial nephrectomy (PN) has been considered the standard treatment for patients with these SRMs . The progression of NSS management has traversed from an open approach to laparoscopic surgery, and now to robotic‐assisted laparoscopic surgery.…”

Renal Mass Biopsy is Associated with Reduction in Surgery for Early-Stage Kidney Cancer

“…Longer-term outcomes are now emerging for active surveillance including a contemporary cohort of 339 patients that did not routinely employ renal mass biopsy 11 ; cancer-specific survival was recently reported to be 100% with many small renal mass patients followed ≥5 years. 11 Therefore, cancer outcomes can be optimized using baseline patient characteristics and tumor size without the need for biopsy, but biopsy may play an economic role and provide additional information to aid some patients in the decision to forgo immediate intervention for a small renal mass. In populations with decreasing cancer prevalence, biopsy becomes more cost-effective when compared to imaging alone.…”

The role of the renal biopsy and surveillance in the management of small renal masses

“…Elderly and comorbid patients with SRM have a relative low risk of CSM but a significant risk of OCM, thus questioning their eligibility for surgery, which may also expose the patient to a greater risk of postoperative morbidity [13][14][15][16][17] . In comparative retrospective and prospective analyses, although patients in the AS arm were older with greater comorbidity and smaller tumors with respect to the surgical counterpart, no statistically significant difference in OS and CSS were observed once adjusted for patients and tumor characteristics [10,13,18,19] .…”